Consent: Microlaryngoscopy - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent. Overview of Procedure A microlaryngoscopy is an examination of the larynx which is often combined with examination of the trachea and primary bronchi (microlaryngoscopy and bronchoscopy, termed MLB) MLB is performed as a diagnostic procedure in the paediatric population to identify or exclude disorders of the airway such as laryngomalacia, tracheomalacia, or laryngeal cleft. Microlaryngoscopy is also used in the adult population to perform procedures in the larynx and airway, such as vocal cord biopsies, excisions, or debulking The procedure is performed under a general anaesthetic and the patient is ventilated with a slim endotracheal tube or with supraglottic ventilation. A rigid laryngoscope is advanced to provide a view of the vocal cords, and a microscope or endoscope (Hopkins rod) may be used to examine the larynx and carry out any procedures required. Welleschik, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons Figure 1A Vocal Cord Nodule, as seen on microlaryngoscopy Complications Intraoperative Complication Description of Complication Potential Ways to Reduce Risk Bleeding Use of adrenaline-soaked patties combined with suction throughout Dental or lip injury Rarely, teeth, gums, or lips may be damaged by the rigid laryngoscope Use a gum-guard throughout Laryngeal injury Ensure all steps are taken under direct vision Anaesthetic risk Includes damage to the teeth or larynx from intubation, adverse reaction to drugs, nausea and vomiting, cardiovascular and respiratory complications. Part of the anaesthetic assessment before an operation Pneumothorax A pneumothorax may occur due to the jet ventilation used during the procedure, albeit very rare Early Complication Description of Complication Potential Ways to Reduce Risk Pain Ensure to prescribe regular simple analgesia post-operatively Laryngeal oedema Laryngeal oedema can develop post-operatively, although is typically mild Dysphonia Bruising to the vocal cords may result in transient hoarseness post-operatively Voice rest postoperatively is recommended, particularly if biopsies or excisions have been performed Aspiration Patients can aspirate saliva or blood during the procedure, which could result in a pneumonia Ensure good suctioning throughout the procedure of all secretions Late Complication Description of Complication Potential Ways to Reduce Risk Need for repeat procedures If further diagnostic information needed or further biopsies required Frequent questions What is microlaryngoscopy? Microlaryngoscopy is a diagnostic procedure that examines the larynx, often combined with bronchoscopy to assess the trachea and primary bronchi. It is used in both paediatric and adult populations to identify airway disorders and perform various interventions on the larynx. What are the common complications associated with microlaryngoscopy? Common complications include bleeding, dental or lip injuries, laryngeal injury, and anaesthetic risks. Measures such as using adrenaline-soaked patties, gum-guards, and ensuring direct vision during the procedure can help mitigate these risks. How is microlaryngoscopy performed? The procedure is conducted under general anaesthesia, where a rigid laryngoscope is inserted to visualise the vocal cords. A microscope or endoscope may be employed to facilitate examination and any necessary interventions on the larynx. What postoperative complications can occur following microlaryngoscopy? Postoperative complications may include pain, laryngeal oedema, dysphonia, and the risk of aspiration. Prescribing analgesia, recommending voice rest, and ensuring proper suctioning during the procedure can help reduce these complications. Why is patient consent important before microlaryngoscopy? Patient consent is crucial as it ensures that the individual is informed about the procedure, its potential risks, and complications. The person obtaining consent must have a thorough understanding of the procedure and adhere to local guidelines and laws regarding patient consent. Rate This Article